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Flashcards in Community Deck (61):
1

What is the organism causing RING WORM?

Tinea Corporis

2

A patient presents with the following at your pharmacy. They ask for some Brolene eye drops. What do you do?

This is a subcojunctival haemorrhage

Ask them if it is painful- any pain then refer

Ask them if they are on WARFARIN- if yes seek medical attention ASAP

Have you had any injury to the eye recently?

If no to the above- reassure the patient that it is self limiting, usually better within 2 weeks and no OTC products are recommended

3

What kind of medication is Guaiphenesin?

Cough EXPECTORANT

These claim to make the coughing easier while enhancing production of mucus and phlegm.

Other example: Acetylcysteine, ammonium chloride

 

Not effective in children

4

What kind of medicine is Dextromethorphan?

Cough suppressant (antitussive)

5

What antihistamine do we usually give to children?

Chlorphenamine maleate

Suitable for 1 year and over

6

What age are steroid nasal sprays e.g. beconase, flixonase, not suitable in?

Under 18's

7

What drugs can be given on instalment prescriptions (FP10MDA) Other than Methadone?

Schedule 2 Controlled Drugs;

Buprenorphine;

Buprenorphine/naloxone (Suboxone); and

Diazepam

8

How is payment for Instalment precriptions worked out?

Payment is based on each occasion the pharmacist provides an instalment to the patient; i.e. each time the patient collects their drug from the pharmacy

Pharmacy needs to fill out back of prescription each time the patient picks up an instalment

9

What formulations have more potential for abuse by addicts?

Sugar free

 

Syrup base less liable to abuse

10

Is it pharmacologically rational for a cough/cold remedy to contain dextromethorphan and guanefenesin? What about dextromethorphan and ammonium chloride?

No:
Dextromethorphan is a cough suppressant so person coughing less

Guanefenesin and ammonium chloride both cough expectorants which means they make it easier to cough things up: work against eachother

11

What is the medication causing drowsniess usually included in cough/ cough rememdies to help people sleep?

Diphenhydramine

A sedating antihistamine, found in things like Night nurse.

Also found in sleep aids such as sominex

12

What is cinnarazine and what is it used in?

characterized as an antihistamine and a calcium channel blocker

Used for travel sickness and vertigo  and tinnitus (problems with inner ear)

Very sedating

Found in Stugeron- 2 tablets 2 hours before travel

13

If a specific brand is stated on a prescription (e.g. Losec capsules- Omeprazole) can you give the generic if you run out of the branded?

No

Must legally prescribe that brand unless you ask the prescriber to change the Rx to generic

14

What does sodium Citrate do to the pH of urine?

Cystitis sachets

It increases the pH- makes urine more alkaline

Acidic urine in cystits- hence the burning feeling

15

Can pseudoephidrine cause drowsniess?

Can guaifenesin cause drowsiness?

Can dextromethorphan?

No

Remember pseudoephidrine (SUDAFED) can be abused- stimulating- side effects include restlessness and insomnia, and hallucinations!

Guaifenesin does not cause drowsiness

Dextromethorphan can cause a little bit of drowsiness

 

16

Children under __ should not be given cough and cold medication OTC containing PSEUDOEPHEDRINE 
PHENYLEPHRINE
DEXTROMETHORPHAN
PHOLCODINE
GUAIFENESIN
Chlorphenamine, brompheniramine, diphenhydramine, doxylamine, promethazine and triprolidine.

Children under 6 years old

Medicines containing:

ANTITUSSIVES (suppressants) (DEXTROMETHORPHAN
PHOLCODINE)

Expectorants (GUAIFENESIN, ipecacuanha)

Nasal decongestants (pseudo, phenylephrine, ephedrine, oxymetazoline, xylometazoline)

Antihistamines: Chlorphenamine, brompheniramine, diphenhydramine, doxylamine, promethazine and triprolidine.

For use in 6-12 years they should be SECOND LINE and be used for no more than 5 DAYS

17

A patient with a productive cough for the last week requests a product containing dextromethorphan because they have heard good things. What do you do?

They may have requested Benylin Dry Cough

Similar product: Benadril Tickly Cough containing Pholcodine

These are cough SUPPRESSANTS

Should NOT suppress a productive cough- need to get the mucous out- so recommend an expectorant (Guaiphenesin)

18

It is recommened people include oily fish in their diet to help reduce CV risk. Can you think of any examples of these?

Mackerel

Salmon

Sardines

19

What is the organism causing athletes foot? How is athletes foot treated?

TINEA PEDIS

Topical imidazole (Miconazole) can be used- Apply twice daily and continue for 10 days after the lesions have healed 

Bnf states under topical antifungals: to prevent relapse these should be continued for 1-2 weeks after healing

Could also consider Griseofulvin

20

Amorolfine (Curanail, Loceryl) can be used for fungal nail infections. What is the directions for this?

Apply 1-2 times a week for:

6 months for finger nails

9- 12 months for toe nails

Apply after filing and cleansing

BNF age limit: 12, OTC age limit: 18. 3 ml pack is a P

21

Why has the safety of using medicines containing codeine to treat coughs and colds in children younger than 18 been reviewed?

Because of the potential for serious problems like slowed or difficult breathing.

Children, especially those who already have breathing problems, may be more prone to these effects

Differences in metabolism of codeine: codeine is converted to Morphine in the body, this cause cause respiratory difficulties.

This use in under 18's only applies to codeine linctus for colds/ cough; codeine containing products for pain relief can still be used in > 12 years, sold to > 16 years. 

22

What do we use to treat Oral thrush?

Topical Miconazole gel- Daktarin oromucosal gel

 

(Nystatin 2nd line, Fluconazole 3rd line if topical preps can't be used/ patient has a dry mouth)

23

What is Lyme disease caused by? What does the rash present as?

Caused by bacterial infection from Tick bites

An early symptom of this condition is a characteristic "bulls eye on a dartboard" rash (called erythema migrans) that isn't itchy

Usually treated with Doxycycline, amoxicillin or cefuroxime for 2-4 weeks

24

Is sunlight a good cure for cold sores?

Sunlight can trigger cold sores so direct sunlight should be avoided and sun screen should be applied.

25

How many days of co-codamol 30/500mg tablets could you give maximum as an emergency supply?

5 days max

As co-codamol contains codeine 30mg which is a schedule 5 CD!

26

Orlistat impaires the absorption of Fat soluble vitamins. Which are the Fat soluble vitamins?

A

E

K

 

Water soluble: B, C 

27

Can GTN be bought OTC?

YES

Both sub-lingual tablets and spray are P medicines

NB: Their effects last for 20-30 minutes, but in an emergency situation, repeat dose after 5 mins if no relief. 

28

Can nursing homes bring their waste medicines to your pharmacy to dispose of?

Can the public: what will you do with the waste?

No- must use their own waste disposal

Only the public can bring it to the pharmacy: this is an essential service for the pharmacy to act as a collection point for waste medicines: sort it into solids, liquids and ampoules and arrange for waste contractor to pick it up.

Must not store waste for longer than 6 months, or over 5 cubic meters

29

What does 'Freshly prepared' mean?

 

What does 'Recently prepared' mean?

Freshly prepared: 24 HOUR EXPIRY

 

Recently prepared: 28 day expiry

30

What is information governance? How often do community pharmacies need to provide IG assurances to the NHS?

Does the Information Governance lead need to be a pharmacist?

IG is all to do with confidentiality and how to handle patient sensitive data.

Pharmacies need to submit IG assurances annually.

The lead does not need to be pharmacist but needs enough authority to make changes in information handling

31

Pseudoephidrine is contra-indicated in which condition?

What about phenylephrine?

Pseudoephedrine: Hypertension, coronary artery disease, MAOI's in the last two weeks

Phenylephrine: diabetes (as may increase glucose) and CV disease 

32

Eye drops containing a lubricant only (e.g. propylene glycol) will expire in _____

6 months

33

Co-amoxiclav oral suspension will have an expiry of ____ once it is made up

7 days

34

Most eye drops will have an expiry of _____. What expiry do chloramphenicol eye drops have, considering they contain an antibiotic?

28 days

 

still 28 days for chloramphenicol- it it just reduced to 14 days on wards at slam. Patients are still advised to discard the drops 5 days after opening (after finishing the course)

35

Oramorph 20 mg/mL solution- schedule? Expiry?

Schedule 2 CD

Anything over 2.6mg/ml (13mg/5ml) is schedule 2

4 month expiry 

The lower strength (2mg/ml) has a 3 month expiry

36

Which emollient does not contain Urea?

hydromol

37

The mainstay of treatment OTC of travel sickness involves antihistamines:

Cinnarizine
Meclozine
Cyclizine

Promethazine: Promethazine Hydrochloride (Phenergan) and Promethazine Teoclate (avomine)

OR Anticholinergics:
Hyoscine 

Which one of these has a 24 hour duration of action?

Which one causes most sedation?

Which is the most effective for the prevention of motion sickness?

24 hour duration: Promethazine Teoclate

Most drowsiness: Promethazine Hydrochloride (Phenergan)

Most effective: Hyoscine hydrobromide

38

What are the likely side effects of the antihistamines/ anticholinergics used in travel sickness?

Dry mouth!

Sedation 

be careful with other medication that can cause sedation: alcohol, TCA's, opioids

39

Which travel sickness medication would be most appropriate for a young child, 4 years old?

Hyoscine hydrobromide (licesned for over 3 years [joy rides]) or meclozine for over 2 years

40

How does plaque psoriasis present?

Silvery white scales, when scraped away pinpoint bleeding occurs from the capillaries 

41

42

What is the only contact lense solution that can be applied whilst contact lenses are still in the eye?

Re-wetting solution

43

If a patient has recently had their tonsills out (tonsillectomy) or adrenal glands out (adrenectomy) what OTC drug is cautioned?

If they have sleep apnoea (i.e. find it hard to breathe at night) then CODEINE is cautioned as can cause respiratory problems which can be fatal (Fatal ADRs reported)

44

What presents as the following image accompanied by sore throat, headache, high temperature?

Scarlet fever 

 

Antibiotics needed- refer

With treatment, most people recover in about four to five days and can return to school 24 hours after starting antibiotic treatment. Without treatment, you'll be contagious for one to two weeks after symptoms appear.

45

Where should Latanoprost eye drops be stored?

In the fridge

46

Where does the new inhaler, Fostair Nexthaler, containing steroid Beclometasone and LABA formoterol, need to be stored?

At room temp

 

Its the old fostair (inhalation solution) that needs to be kept in a fridge

47

Which eye drops used in glaucoma can cause a change in eye colour?

Prostaglandin analogues:

BIMATOPROST
LATANOPROST
TRAVOPROST

48

What do the yellow and what do the pink Migraleve tablets contain, and what is the max of each to be taken in 24 hours?

Pink: Paracetamol, codeiene, Buclizine 

Yellow: Paracetamol, codeine

 

Max in 24 hours: 2 pink + 6 yellow

49

What is a buldging spot on a babies forehead accompanied by vomiting, fever, cold hands likely to indicate?

early signs of meningitis- refer to A and E!

50

What are the signs and symptoms of Otitis externa?

itching

irritation 

Some discharge

Oedematous (fluid build up) leading to conductive hearing loss
Ear canal/ external ear are red, swollen and eczema like 

51

What does treatment of Otitis externa involve?

ACETIC ACID (earcalm spray)- one spray to the affected ear TDS, max frequency 2-3 hours, continue for 2 days after symptoms gone 

 

Choline salicylate drops- Earex Plus

52

Referral symptoms for ear conditions? (Considering Otitis Externa and Ear wax are the only ones that can be treated OTC!- Need to rule out otitis media- infection of inner ear)

Mucopurulent discharge (pus)- otitis media

Pain on palpitation of the mastoid area

Generalised inflammataion of the pinna

Impaired hearing in a CHILD

Slow-growing growths in elderly

Symptoms present over 4 days

53

What are simeticone drops indicated for?

Infant colic- excessive, frequent crying in a baby

One week trial of simeticone drops recommended: drops are designed to help release bubbles of trapped air in your baby's digestive system.

54

How is allergic rhinitis differentiated from the common cold? What are reatment options OTC for this?

Allergic rhinitis presents as: sneezing, rhinorrhoea and nasal itching

Could use:

Loratidine- 1st line

2nd line: Sodium cromoglicate nasal drops (but take 1-2 weeks to work)- a mast cell stabiliser 

Or steroid nasal spray (over 18's)

Other options:

Azelastine- the only nasally administered antihistamine OTC

chlorphenamine (antihistamines)

55

Can you get monoxidil on NHS prescription?

NO

56

If patients are using several topical agents, when should the emolient be applied?

How often can emollients be applied?

Before.... Leave at least 5 mins  between applying to allow absorption. 

emollients contain no active so can be applied as many times.. but general guidance is 2-3 times a day. 

57

We say that stimulant laxative are not first line constipation remedies, however when may we chose to recommend it?

If someone has been constipated for a while e.g. 10 days (refer if over 14 days) as these work quickly (6-12 hours) so may be appropriate for one-off use.

58

Can Gaviscon be used in pregnant women suffering from gastro-oesophagul reflux ?

Yes: remember your acronym APPLE: A= Antacids

Acid reflux is common in preganancy when the baby gets larger towards the end: they respond well to Alginate products like Gaviscon- can take through the day and night

59

If a patient using Benzoyl Peroxide experiences drying, burning or peeling of the face, should they stop using the product?

Just advise reducing the frequency of administration- stop using for a day or two then reduce to OD or use on alternate days

60

We know codeine should  be avoided for pain in children 12-18 years where possible. Who would you chose to give codeine to out of a 24 year old ethiopian man and a 31 year old Norweigan man?

The norweigan man

African/ ethiopian and middle eastern people are more likely to be ultra-rapid metabolisers of codeine so do not give to these patients.

61

What condition presents with a rash, white coating of the tongue, plus headache and fever leading up to it?

Scarlet fever